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  03:42:44 pm, by MedBen5   , 758 words,  
Categories: Health Plan Management

The ACA 2012 Health Plan "To Do" List

With the second anniversary of the passage of the Affordable Care Act fast approaching, it’s an appropriate time to look forward to what health plans have to do to comply with reform law in 2012. Fortunately, it’s a pretty quiet year from a compliance perspective – or at least it was, until the Department of Labor released the final SBC regulations a few weeks back.

The most intriguing aspect of reform in 2012 is, arguably, the “unknown". In March, the Supreme Court hears the cases brought by 26 states and others regarding the ACA’s constitutionality. Then in November, the Presidential election takes center stage. Both events carry the potential to alter portions of the law, or even strike it down altogether.

So while we wait for this drama to unfold, here are a few things plan administrators need to make sure to do:

Transitional Annual Plan Maximums – Effective for plan years on or after January 1, 2012, all plans that are taking advantage of the transitional annual plan maximum must make sure to increase the overall plan maximum to no less than $1,250,000.00.

Explanation of Benefits – Effective for plan years on or after January 1, 2012, all non-grandfathered plans need to make sure that they are including required language on EOBs, including references to foreign language EOB availability and additional remark and denial codes. MedBen has made the required changes to our EOBs for groups affected by this requirement.

External Review Procedures – Effective January 1, 2012, all health plans must have contracted with at least two Independent Review Organizations (IROs). By July 1, 2012, all health plans must have contracted with at least three IROs. On behalf of our clients, MedBen has contracted with two IROs for external review purposes and is in the process of reviewing a third.

Full story »

  02:03:50 pm, by MedBen5   , 211 words,  
Categories: News, Prescription, Wellness

Weight-loss Drug To Undergo Second FDA Review

On Wednesday, a weight-loss drug gets a second chance to impress the Food and Drug Administration. The New York Times reports that a committee of outside advisers to the agency will weight the benefits of the drug, called Qnexa, against concerns that it may cause birth defects and heart problems.

Qnexa is a combination of two existing drugs: the stimulant phentermine and the epilepsy and migraine drug topiramate, also known by the brand name Topamax. Some doctors already prescribe (legally) the pair to obese patients.

The FDA rejected Qnexa in 2010 following reports that the drug increases the risk of a heart attack, and that use of topiramate during pregnancy may be linked to oral clefts, such as cleft lip, in newborns. Drugmaker Vivus had then proposed that Qnexa be allowed on the market with a warning against its use by women of childbearing potential – a suggestion rejected by the FDA as overly broad.

Clinical trials of Qnexa have shown that in addition to losing weight, users had improvements in blood sugar, blood pressure and cholesterol compared to those given placebos. Even so, the advisory committee may request the Vivus conduct an additional trial to further assess the risk of heart attack – a process that could delay approval by years.

  10:59:45 am, by MedBen5   , 262 words,  
Categories: Health Plan Management

WSJ Op-ed: Health Spending Declined During Last Decade

Annual Percentage Change in Health Spending, 2000-2010

In a Wall Street Journal opinion piece, J.D. Kleinke of the American Enterprise Institute argues that better medical care and consumer choice have contributed to slowing the growth rate of national health expenditures over the past decade:

“As the graph nearby shows, the growth rate of national health expenditures, according to data compiled by the Centers for Medicare and Medicaid Services, has been moderating since 2002.

“The moderation has been driven by cumulative improvements in medical care and by insurers, and by marketplace disciplines on the demand for medical care. Consumers are finally getting more involved in managing and paying for their own care.

“Contrary to the perennial doomsaying, the health-care system is – almost in spite of itself – getting better. A generation of breakthrough drugs for chronic disease, mental illness, HIV and cancer were developed in the 1980s and ’90s at great cost. Dozens of these drugs – like Zocor for heart disease or Zyprexa for schizophrenia – are now widely available, many in generic form. There are now countless electronic ways of telling patients about them. And health insurers are driven by their own evolving market disciplines to make sure patients start taking them and keep taking them in the cheapest available versions.

“Combine all these new medicines, information channels and business compulsions with the slow, steady transfer of economic responsibility for health care – from corporate and government bureaucrats to consumers and their families – and suddenly health-care starts to look almost like an actual market.”

Read the rest of Mr. Kleinke’s comments on the WSJ website.


  05:09:47 pm, by MedBen5   , 195 words,  
Categories: News, Prescription, Wellness

Many Online Drug Sellers Skimp On Critical Info

Here’s a eye-opener for anyone who has thought about bypassing their doctor and buying medications online without a prescription: Most websites that sell Lipitor and other cholesterol pills fail to provide vital information about contraindications (factors which may increase the drug’s risk), key warnings and side effects.

The Pharmalot blog reports that a recent British study found that the 92% of the websites were lacking general contraindications, while information about contraindicated medicines was absent on 47.3%. Warnings were missing about symptoms associated with myopathy (37% absent), liver disease (48%), hypersensitivity (9%) and pancreatitis (96%). Only 7% listed side effects compatible with current prescribing infomation.

“This has potentially serious implications for the safety of purchasers who may not be aware of the problems associated with ordering medicines online or the actual medication, which they receive. Direct to consumer advertising websites need tighter controls,” wrote the authors in the latest issue of Pharmacoepidemiology & Drug Safety.

The study also noted that 95% of the websites didn’t bother to mention that the drugs were precription-only, and 92% didn’t state that they should only be taken by adults. And just 46% of the sites noted that the buyer should speak with a physician if they’re aleady using other medicines.

  04:03:26 pm, by MedBen5   , 138 words,  
Categories: News, Health Plan Management

Tax Credit Spurs Small Businesses To Cover Employees

As part of an effort to encourage more small businesses to provide health care coverage, the Obama administration has expanded the Affordable Care Act’s healthcare tax credit to $14 billion in its proposed fiscal 2013 budget.

According to Modern Healthcare, the proposal would raise the size of small businesses allowed to claim tax credits from the existing 25 or fewer workers to 50. Additionally, the tax credits themselves will cover up to 50% of employee premiums beginning in 2014, a 15% increase from the current standard.

“We need to make it easier for small-business owners to provide insurance to their employees right now,” said Karen Mills, the administrator of the Small Business Administration, in a conference call with reporters Thursday.

The administration also said it would promote greater interest in the healthcare tax credit plan by better publicizing the incentives and simplifying the application process.

  03:07:34 pm, by MedBen5   , 237 words,  
Categories: Wellness

Some "No Sweat" Tips To Reduce Perspiration

It’s Friday, and therefore, the perfect time to talk sweat.

It’s one of life’s little injustices that some people just tend to perspire more than others. Occasionally, heavy sweating may be caused by a medical condition or medication, in which case your doctor may be able to help.

Most of the time, however, it’s the simple combination of genes and environment that determine our level of perspiration. Fortunately, there are ways to keep sweat to a minimum, regardless of circumstances. WebMD has put together a list of helpful hints on its website – we’ll highlight a few here.

  • Stopping Heavy Sweating. Switch to higher-strength deodorants and anti-perspirants. And if you apply your deodorant in the evening rather than the morning, that gives the active ingredient time to clog the sweat duct.
  • Sweating During Exercise. Wear lightweight, breathable fabrics, such as cottons, and wash them before rewaering. If sweaty feet are a problem, use foot powders and change your shoes and socks oftern.
  • Sweating on the Job. Reapply your deodorant or anti-perspirant in the middle of the day – or before a stressful meeting. Wear an inner layer, such as an undershirt or an absorbent camisole, to help soak up some of the sweat. And avoid spicy food at lunch.
  • Nighttime Sweating. Favor breathable, lightweight bed linens year-round, and pick sheets made of aborbent cotton rather than silk or flannel. And skip the down comforter, even in winter.


  05:30:01 pm, by MedBen5   , 217 words,  
Categories: News, Wellness, Health Plan Management

Many Baby Boomers Not Getting Eye Exams

Most older members of the U.S. workforce have vision care coverage, but not all of them take full advantage of their benefits, Employee Benefit News reports.

A recent Transitions Optical survey found that 79% of baby boomers have enrolled in a group vision plan. However, one-third of them say that don’t bother to schedule regular eye exams – leaving them at a higher risk for age-related vision problems and chronic conditions that affect eye health and compromise productivity.

“A quality vision benefit is important for everyone, but especially for employees ages 45 and older, who are more likely to experience vision problems that hurt job performance. This age group also has a higher risk for developing costly eye diseases and whole body conditions such as diabetes and hypertension, all of which can be detected through comprehensive eye care,” says Pat Huot, director of managed vision care at Transitions Optical.

MedBen encourages its customers to get their eyes checked regularly. Our VisionPlus plan promotes early detection and treatment of vision abnormalities by covering exams, basic lenses and selected extras in full when using a network provider. In addition, the program also provides the highest quality ophthalmic materials at extremely affordable prices.

To learn more about MedBen VisionPlus, contact MedBen Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.

  04:29:37 pm, by MedBen5   , 177 words,  
Categories: News, Prescription, Health Plan Management

Birth Control Solution Fails To Address Self-Insurance Question

The birth control compromise offered by the Obama administration quelled – momentarily, at least – a growing political headache. But, as the New York Times notes, it ignored one conspicuous point.

To appease religiously-affiliated employers that oppose contraceptive usage, the administration announced last week that insurers, rather than the organizations, would be required to cover women’s birth control costs in full. Trouble is, many of these organizations self-fund their employee health care benefits – which means that they serve as their own insurers, and therefore, are still responsible for covering the costs.

So far, the administration has only said that the details will be worked out with religious leaders in the coming weeks. But some aren’t confident that a suitable solution can be reached.

“Putting the obligation on the insurer and not the employer doesn’t help much if they are the same person,” said Richard M. Doerflinger of the United States Conference of Catholic Bishops. Ironically, several Catholic organizations went the self-insurance route in order to avoid similar birth control mandates already present in certain states.

  03:50:02 pm, by MedBen5   , 197 words,  
Categories: News, Wellness

Swapping Sugary Soda For Water Helps Weight Loss

Often, making just a small change to your diet can make a big difference if you’re trying to shed a few pounds. Case in point: A new clinical trial found that participants who replaced sugar-sweetened soda with water (or a diet beverage) nearly doubled their likelihood of meaningful weight loss.

According to Reuters, researchers divided 300 overweight adults into three groups. The first and second groups substituted sugary soda for, respectively, water and diet drinks, while the third was given weight-loss advice but could make their own beverage choices.

After six months, all three groups lost an average of four or five pounds. But 20% of the first two groups dropped at least 5% of their starting weight, compared to only 11% of the third group. And while that may not seem like much, it’s enough for the body to realize such healthful benefits as a reduction in blood pressure.

Lead researcher Deborah F. Tate, of the University of North Carolina at Chapel Hill, advised that people who have a hard time with a major diet overhaul can start with sugar-free drinks before making changes to eating habits. “This is a simple thing you can do consistently each day,” she said.

  03:00:45 pm, by MedBen5   , 168 words,  
Categories: News, Wellness, Health Plan Management

U.S. Doctors' Group Attempts To Stem Excessive Testing

In an effort to reduce excessive medical testing, the American College of Physicians (ACP) is releasing guidelines to aid physicians in determining whether or not patients should screen for specific disesases.

“Excessive testing costs $200 billion to $250 billion (per year),” Dr. Steven Weinberger, CEO of ACP said in an interview to Reuters. “There’s an overuse of imaging studies, CT scans for lung disease, overuse of routine electrocardiograms and other cardiac tests such as stress testing.”

Ordering unneeded tests while health care costs continue to escalate constitutes “medical gluttony,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. “We have got to think about the rational use of medicine in order to avoid rationing medicine.”

By handling the situation in-house, as it were, the ACP is hoping to avoid further government intervention. But MIT healthcare economist Dr. Jonathan Gruber believes that’s precisely what is needed.

“I don’t trust professional societies to do it because that’s how they make money – by doing tests and procedures,” Gruber said.


  12:01:27 pm, by MedBen5   , 161 words,  
Categories: News, Wellness

Pediatricians More Likely To "Fire" Families Who Refuse Vaccines

An interesting article in today’s New York Times: Pediatricians are increasingly “firing” families whose parents refuse to allow their children to be vaccinated.

Medical associations don’t recommend such patient bans. But a 2011 study of Connecticut pediatricians found that 30% of 133 doctors said they had asked a family to leave their practice for refusing vaccines, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.

While rates for several key innoculations in young children rose between 2009 and 2010, lower overall immunization rates have been blamed as a factor in U.S. outbreaks of whooping cough and measles in recent years. And some pediatricians are concerned that unimmunized patients may pose a danger in the waiting room to infants or sick children who haven’t yet been fully vaccinated.

Parents who refuse vaccinations often voice concerns that the innoculations increase the risk of autism or may overwhelm their child’s immune system. But recent studies have dispelled these concerns among scientists.

  10:13:11 am, by MedBen5   , 258 words,  
Categories: News, Prescription, Wellness, Health Plan Management

Contraceptive Compromise Offered, But Question Of Cost Remains

As we noted here last week, President Obama has proposed a compromise regarding the mandate that religiously-affliated businesses cover contraceptive services. But even if the Catholic Church accepts the work-around, questions and controversy remain.

From Insureblog, third party administrator Nate Ogden points out that “free” contraceptives are anything but:

“When employers pay claims under a self funded plan, the majority of the time that is coming right out of the employer’s general account. So while it may seem like it’s ‘free’ to the employees (just like it seems like it’s ‘free’ to folks on fully insured plans), it’s really coming out of their raises, bonuses, even salary.

“Which brings up the first big question, one that hasn’t seen much (if any) press:
What birth control is provided for free? Can we cover the generic 100%, or if their doctor prescribes something new at $500 per month are we stuck covering that 100% as well? Remember, it’s not the insurance company getting stuck with the bill here.”

And at Slate, Matthew Yglesias offers the counterpoint:

“While birth control costs more than nothing, it costs less than an abortion and much less than having a baby. From a social point of view, unless we’re not going to subsidize consumption of health care services at all (which would be a really drastic change from the status quo) then it makes a ton of sense to heavily subsidize contraceptives… The unfortunate thing is that under the American setup the subsidies tend to be passed through the employer, which has set the stage for this controversy.”


  03:18:17 pm, by MedBen5   , 172 words,  
Categories: News, Wellness

Doctors Advise Exercise To A Third Of Patients

Physicians are prescribing more than ever these days – and drugs have nothing to do with it. A new report from the Centers for Disease Contral and Prevention says that one-third of adults who saw a doctor or other health care professionals in 2010 were advised to exercise more.

According to WebMD, the number of patients being told to increase their physical activity as a way to maintain or improve their health has jumped significantly since 2000, when less than a quarter of consulations included such advice.

“Trends over the past 10 years suggest that the medical community is increasing its efforts to recommend participation in exercise and other physical activity that research has shown to be associated with substantial health benefits,” states the report, from the CDC’s National Center for Health Statistics.

Doctors most typically prescribe exercise to their overweight and obese patients. The report indicates that this increased emphasis is an important development, as patients tend to follow their doctor’s counsel – especially if the doctor follows up after the initial prescription.


  05:16:30 pm, by MedBen5   , 274 words,  
Categories: News, Health Plan Management

Department of Labor Releases Final SBC Regulations

On Thursday, the Department of Labor released the Final Regulations describing a plan sponsor’s responsibilities for preparing and distributing the 4-Page Summary of Benefits and Coverage (SBC). The template for the 4-Page (double-sided) Summary has not changed significantly from the earlier proposed regulations and the Final Regulations require compliance for plan years on or after September 23, 2012.

MedBen is in the process of reviewing the Final Regulations and will provide for its clients a summary of the requirements, but in the meantime, additional information can be found on the Department of Labor’s Employee Benefits Security Administration website:

Summary of Benefits and Coverage and Uniform Glossary

MedBen clients who have any immediate questions may contact MedBen Vice President of Compliance Caroline Fraker at (800) 851-0907.

  05:07:10 pm, by MedBen5   , 175 words,  
Categories: News, Wellness, Health Plan Management

President Obama Revises Birth Control Coverage Requirement

In response to escalating criticism from political opponents and members of his own party, today President Obama has reversed the requirement that religiously-affilated employers provide birth control coverage to women.

The Washington Post reports that women who work for affliated non-profit schools, charities, universities, and hospitals will still be guaranteed free coverage for contraceptive services, but must get such coverage directly from their insurance companies. Churches remain exempt from the requirement, which means that their female employes cannot obtain separate contraceptive coverage.

“After many genuine concerns were raised over the last few weeks – and the more cynical desire to make this into political football – it became clear that spending months hammering out a solution was not an option; we had to move this faster,” Obama said during a conference earlier today.

A senior White House official, speaking to reporters about the revised rule, said that the change would have no cost impact on insurers, and could potentially save money by reducing unwanted pregnancies and other conditions that could be avoided by birth control.

  02:13:28 pm, by MedBen5   , 157 words,  
Categories: News, Health Plan Management

Growth Rate Of Health Care Spending Slow In 2011

The National Journal reports that health care spending increased just 4.4% from 2010 to 2011, among the slowest rate of growth in the past 50 years.

According to a report by the nonprofit Altarum Institute, the $2.70 trillion spending rise “represents an increase over the government’s official estimate of spending growth in 2010 (3.9%) that was released last month.”

As health spending makes up nearly one-fifth of the gross domestic product, any sign that growth is health spending is slowing is a positive development, Altrarum noted. The group also reported that this ranks as the third slowest rate of growth since national health expenditures have been tracked.

“The health spending share of gross domestic product was 18.1% in December 2011, up from 16.4% at the start of the recession (December 2007), but down slightly from the all-time high of 18.2% in June 2011,” the report reads. “Altarum’s data indicate that health care price inflation was only 2.1% for all of 2011, the lowest annual figure since 1998, when it stood at 2%.”

  01:13:52 pm, by MedBen5   , 150 words,  
Categories: News, Wellness

Trans Fat Levels Fall In Foods -- And Bloodstreams

Remember all that talk a few years back about how bad trans fats are for you, and that food makers should cut back on them? Apparently, someone took it to heart (so to speak).

According to the New York Times, a new National Institutes of Health report says the level of trans fatty acids in white Americans’ bloodstreams decreased 58% from 2000 to 2009. Additionally, levels of LDL, or “bad” cholesterol, fell almost 10 units on average, while levels of HDL, or “good” cholesterol, rose over 6 units.

Trans fats have been linked to an elevelated risk of heart disease. The drop in their levels coincides with a concerted effort to remove them from fried, baked and packaged foods. Some major cities, including New York and Philadeplia, have also banned their use in restaurants.

In the study, researchers obtaimed blood samples from 521 Americans with an average age of 47. Participants were tested in 2000 and again in 2009.


  05:02:49 pm, by MedBen5   , 182 words,  
Categories: News, Wellness

Honesty Not Always The Best Policy, Doctor Survey Reveals

A new study of physician honesty finds that doctors aren’t above the occasional fib, if they feel it serves the best interest of their patients – or themselves.

The Wall Street Journal Health Blog reports that the Health Affairs survey of 1,891 doctors nationwide revealed that more than half of respondents sugar-coated a patient’s prognosis at least once in the past year. And about 11% admitted that they told an outright lie to an adult patient or child’s guardian.

Respondents also fessed up about other medical transgressions. Over one-quarter said that they’d shared confidential patient information with an unauthorized persion, while nearly 20% reported not fully disclosing an error to a patient because they feared a lawsuit.

The study didn’t delve into specifics about why respondents lied, so it’s possible that there may be a good reason behind their actions. But “at the end of the day, patients need accurate information about their health” in order to make the best decisions about their care, says Lisa Iezzoni, an author of the study and director of the Mongan Institute for Health Policy at Massachusetts General Hospital.


  04:37:27 pm, by MedBen5   , 367 words,  
Categories: Announcements, News, Health Plan Management

MedBen IS Team Putting Final Touches On HIPAA Updates

Members of the MedBen Information Systems team worked diligently throughout 2011 to see that new Centers for Medicare & Medicaid Services guidelines for electronic transmission of administrative transactions were in place by the original December 31 deadline. And while the CMS deadline has been extended until March 30, we already have completed the computer coding necessary for seamless interactions with physicians, hospitals and other medical facilities.

HIPAA 5010 guidelines were created to ensure that health benefits administrators and providers use a common set of standards for the transmission of claims submissions, explanations of benefits (EOBs) and related transactions. By doing so, we make certain these processes maintain security and uniformity. Once final testing is completed, MedBen will be in full compliance with HIPAA 5010.

MedBen has made multiple system changes so electronic EOBs remain HIPAA-compliant – and these changes have the added benefit of providing greater accuracy and processing speed. For instance, a new “Primary Carrier” entry screen allows for more detailed coordination of benefits information on transmitted EOBs, which reduces the need for follow-up calls and letters. And “Splitting/Bundling” screens can automatically separate or combine treatment information when appropriate, so our providers receive a precise breakdown of how their claims were processed.

Full story »

  01:06:25 pm, by MedBen5   , 207 words,  
Categories: News, Wellness, Health Plan Management

Birth Control Mandate Spawns Backlash, Potential Compromise

The Obama administration may attempt to find middle ground with Catholic universities and hospitals in regard to the controversial rule that health insurance plans must cover birth control, Reuters reports.

Speaking on MSNBC, presidental adviser David Axelrod said that religious institutions can use the 12-month grace period to find a solution that doesn’t violate Catholic Church doctrine. “We certainly don’t want to abridge anyone’s religious freedom so we’re going to look for a way to move forward that both guarantees women that basic preventive care that they need and respects the prerogatives of religious institutions,” Axelrod said.

The Catholic Church has expressed outrage against the rule, which was implemented to reduce unwanted pregnancies by giving more women access to birth control. Church officials say affiliated institutions will be forced to go against Church teachings.

And the backlash over the rule has extended beyond church members, The Hill reports. Presidential candidate Mitt Romney has launched a petition against the mandate, and conservative leaders have attacked the administration for the decision.

Even some Obama supporters have questioned the political wisdom of the birth control requirement. Left-leaning Washington Post columnist E.J. Dionne wrote that the administration “utterly botched” the issue and “threw his progressive Catholic allies under the bus.”

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